The institution that employs me is very bullish on customer satisfaction.  Having come from a fourteen year stint in private practice before I came back into the university fold six years ago, the little things that make a practice run smoothly come naturally to me. Patients are typically seen within a week of the consultation request -- same day if they are in an emergency situation.  My front office staff actually ...

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How dare you! Life can change in a heartbeat. Most of us believe that our lives, our loves and all the that things that make us who we are is a gift from a higher power. One that can be taken away as swiftly as it is given. But somewhere in the shuffle of taking kids to practice, catching up on emails, worrying about bills, and the search for the perfect ...

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I had thought that apologizing was a straightforward act, but I now realize that it is a nuanced art form. We’ve all heard the "mistakes were made" version, usually issued by politicians who attempt to insert a layer of passive voice insulation between themselves and their screw-ups. There is also the ever present conditional apology which by definition falls short of complete responsibility acceptance. The template here is: “I’m sorry for ...

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In the North American hemisphere flu season is here. Influenza, as most people know, is a serious respiratory infection that can be life-threatening in the very young and the very old. Some strains, as we’ve all heard about in the press in the past, are more deadly than others and may threaten even the strong. Luckily, however, we’ve developed a vaccine. It doesn’t guarantee you won’t get the flu: the ...

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So a guy has his car towed to the mechanic. All four tires are slashed. He has a simple request. Please replace the tires. But this is one of those comprehensive care mechanics. He not only examines the tires, he does a full once over. He pops the hood and immediately knows that the engine is shot. It's fried. The cost of fixing the engine is more than the value of the ...

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As an advocate of patient-centered care, I have to recognize that some varieties of patient-centrism make me more comfortable than others. If I really want the patient to do X, and the patient doesn’t want to, I generally feel okay about that. Frustrated, sure, and often times convinced that my way is the right way and the patient’s way is some sort of detour. Most often, though, I am able to ...

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If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications. Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover ...

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Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were ...

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To err is human. To really screw things up, you need government. One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year. Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and ...

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As we've gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method. As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal medicine residents. A series of talks on key topics of the patient-centered medical home has been developed, and several faculty experts have been delivering these to the residents. As a part ...

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